Clinical course and treatment of incidentally detected splanchnic vein thrombosis: an individual patient data meta-analysis.

BACKGROUND: The clinical relevance and management of incidental splanchnic vein thrombosis (SVT) remain poorly defined. OBJECTIVES: The objectives of this study were to evaluate the clinical course of incidental SVT in comparison with symptomatic SVT and assess the safety and effectiveness of anticoagulant treatment in incidental SVT. METHODS: Individual patient data meta-analysis of randomized controlled trials or prospective studies published up to June 2021. Efficacy outcomes were recurrent venous thromboembolism (VTE) and all-cause mortality. The safety outcome was major bleeding. Incidence rate ratios and 95% CIs for incidental vs symptomatic SVT were estimated before and after propensity-score matching. Multivariable Cox models were used considering anticoagulant treatment as a time-varying covariate. RESULTS: In total, 493 patients with incidental SVT and 493 propensity-matched patients with symptomatic SVT were analyzed. Patients with incidental SVT were less likely to receive anticoagulant treatment (72.4% vs 83.6%). Incidence rate ratios (95% CI) for major bleeding, recurrent VTE, and all-cause mortality in patients with incidental SVT compared with symptomatic SVT were 1.3 (0.8, 2.2), 2.0 (1.2, 3.3), and 0.5 (0.4, 0.7), respectively. In patients with incidental SVT, anticoagulant therapy was associated with a lower risk of major bleeding (hazard ratio [HR] 0.41; 95% CI, 0.21 to 0.71), recurrent VTE (HR 0.33; 95% CI, 0.18 to 0.61), and all-cause mortality (HR 0.23; 95% CI, 0.15 to 0.35). CONCLUSION: Patients with incidental SVT appeared to have a similar risk of major bleeding, a higher risk of recurrent thrombosis, but lower all-cause mortality than patients with symptomatic SVT. Anticoagulant therapy seemed safe and effective in patients with incidental SVT.

Prevalence of atherogenic dyslipidemia, related factors and level of lipid control in the general population of Galicia. GALIPEMIAS study. / Prevalencia de dislipemia aterogénica, factores relacionados y grado de control lipídico en la población general de Galicia. Estudio GALIPEMIAS.

OBJECTIVES: GALIPEMIAS is a study designed to establish the prevalence of familial dyslipidemia in the general population of Galicia. The objective of the present study was to assess the prevalence of atherogenic dyslipidemia (AD), its relationship with other cardiovascular risk (CVR) factors, and the degree of lipid control. METHODS: Cross-sectional study carried out in the general population over 18 years of age residing in Galicia and with a health card from the Galician Health Service (N=1,000). Selection of the sample by means of random sampling by conglomerates. The AD prevalence adjusted for age and sex and the related variables were analyzed. RESULTS: The prevalence of AD adjusted for age and sex was 6.6% (95% CI: 5.0-8.3%). Arterial hypertension, altered basal glycemia, type 2 diabetes mellitus and cardiovascular disease were more frequent in subjects with AD than in the rest of the population. 47.5% of the subjects with AD had a high or very high CVR. Lipid-lowering drugs were received by 38.9% (30.5% statins) of the participants with AD (46.1% of those with high and 71.4% of those with very high CVR). 25.4% of the subjects with AD had target LDL-c levels, all of them with low or moderate CVR. CONCLUSIONS: The prevalence of AD in the general adult population of Galicia is not negligible, and it was related to several CVR factors and cardiovascular disease. Despite this, this lipid alteration was underdiagnosed and undertreated.

Vena Cava Atresia and Deep Vein Thrombosis: A Case Report and Systematic Review.

Congenital anomalies of the vena cava often go unnoticed, and their incidental finding is frequent in imaging tests performed for another cause in asymptomatic patients. However, an association with the development of thromboembolic disease has been described, mainly in young patients. We report the case of a young woman with deep vein thrombosis associated with vena cava atresia. We conducted a search of the PubMed/Medline database. The search identified 17 articles, of which 5 were selected for extraction and data analysis. Twelve studies were excluded because they failed to match the main criteria. We identified six new cases of deep vein thrombosis associated with vena cava abnormalities, with a mean age of 42.5 years; 83.3% were male. Regarding clinical manifestations, all patients presented as deep vein thrombosis, one case of recurrence, and another case associated with the kidney and inferior vena cava abnormalities with leg thrombosis syndrome. Only one patient had a target triggering factor (cholecystectomy postoperative). The thrombophilia study was negative in all cases and none of the patients died. Treatment included enoxaparin and vitamin K antagonists. This is the first study to report on a systematic review of vena cava atresia associated with deep vein thrombosis in Spain. It shows that in this region, the disease affects young population-even in the absence of risk factors-and is linked to a low mortality. The most frequent presentation form was deep vein thrombosis. Therefore, congenital abnormalities of the vena cava should be suspected in young patients with thromboembolic disease, due to their implications regarding to the duration of anticoagulant treatment, as well as their possible association with other prothrombotic factors.

Effect of high versus low dose of dexamethasone on clinical worsening in patients hospitalised with moderate or severe COVID-19 pneumonia: an open-label, randomised clinical trial.

BACKGROUND: Low-dose dexamethasone demonstrated clinical improvement in patients with coronavirus disease 2019 (COVID-19) needing oxygen therapy; however, evidence on the efficacy of high-dose dexamethasone is limited. METHODS: We performed a randomised, open-label, controlled trial involving hospitalised patients with confirmed COVID-19 pneumonia needing oxygen therapy. Patients were randomly assigned in a 1:1 ratio to receive low-dose dexamethasone (6 mg once daily for 10 days) or high-dose dexamethasone (20 mg once daily for 5 days, followed by 10 mg once daily for an additional 5 days). The primary outcome was clinical worsening within 11 days since randomisation. Secondary outcomes included 28-day mortality, time to recovery and clinical status at day 5, 11, 14 and 28 on an ordinal scale ranging from 1 (discharged) to 7 (death). RESULTS: A total of 200 patients (mean±sd age 64±14 years; 62% male) were enrolled. 32 (31.4%) out of 102 patients enrolled in the low-dose group and 16 (16.3%) out of 98 in the high-dose group showed clinical worsening within 11 days since randomisation (rate ratio 0.427, 95% CI 0.216-0.842; p=0.014). The 28-day mortality was 5.9% in the low-dose group and 6.1% in the high-dose group (p=0.844). There was no significant difference in time to recovery, and in the seven-point ordinal scale at days 5, 11, 14 and 28. CONCLUSIONS: Among hospitalised COVID-19 patients needing oxygen therapy, high dose of dexamethasone reduced clinical worsening within 11 days after randomisation, compared with low dose.

Filtro de vena cava y embarazo: algunas certezas y muchas incertidumbres / Vena cava filter and pregnancy: some certainties and many doubts

El embarazo constituye un estado protrombótico durante el cual se producen en la mujer cambios anatómicos y fisiológicos que conllevan un incremento en la incidencia de fenómenos tromboembólicos. Así, las mujeres embarazadas tienen un riesgo 5 veces mayor de padecer un evento tromboembólico que las no embarazadas. La enfermedad tromboembólica venosa es una causa importante de morbilidad y mortalidad maternas y la embolia pulmonar es la causa más común de mortalidad materna en los países desarrollados. En el presente trabajo se revisan aspectos como la valoración de riesgo tromboembólico en la mujer embarazada, el diagnóstico, profilaxis y tratamiento, con especial atención al uso del filtro de vena cava en mujeres embarazadas en términos de indicaciones, colocación, efectividad, complicaciones y riesgos tanto para la madre como para el feto. (AU)

Pregnancy constitutes a prothrombotic state during which anatomical and physiological changes occur in women. This situation leads to an increase in the incidence of thromboembolic phenomena. Thus, pregnant women have a 5 times increased risk of suffering a thromboembolic event than non-pregnant women. Venous thromboembolic disease is a major cause of maternal morbidity and mortality, and pulmonary embolism is the most common cause of maternal mortality in developed countries. In the present work, aspects such as the assessment of thromboembolic risk in pregnant women, diagnosis, prophylaxis and treatment are reviewed, focusing on the use of the vena cava filter in pregnant women in terms of indications, placement, effectiveness, complications and risks for both mother and fetus. (AU)

Manejo perioperatorio de los anticoagulantes orales de acción directa en procedimientos invasivos-quirúrgicos programados. Historia de un claroscuro / Perioperatory management of direct action oral anticoagulants in programmed invasive-surgical procedures

En la actualidad los pacientes tratados con anticoagulantes orales de acción directa (AOAD) son un grupo poblacional cada vez más frecuente en nuestros centros sanitarios. Las recomendaciones de manejo de estos pacientes, que van a ser sometidos a pruebas invasivas-diagnósticas o quirúrgicas con carácter programado, está recogidas en guías de práctica clínica y revisiones. Sin embargo hasta la fecha, todas las guías tienen el grado de evidencia de recomendación de expertos. Recientemente con la publicación del estudio PAUSE las recomendaciones existentes probablemente cambien. En esta revisión se hace mención a diferentes aspectos en relación con el manejo perioperatorio de los pacientes tratados con AOAD y a las controversias existentes. (AU)

Currently, patients treated with direct-acting oral anticoagulants (DAOAs) are an increasingly frequent population group in our health centres. The management recommendations of these patients, which are going to be subjected to invasive-diagnostic or surgical tests on a scheduled basis, are included in clinical practice guidelines and reviews. However, to date, all guides have the degree of evidence of expert recommendation. Recently with the publication of the PAUSE study the existing recommendations are likely to change. This review refers to different aspects in relation to the perioperative management of patients treated with DAOAs and the existing controversies. (AU)

Fusobacterium Nucleatum Empyema: An Atypical Presentation.

A 40-year-old man presented to the emergency room and was evaluated in the internal medicine department for unexplained weight loss, asthenia, anorexia and night sweats over the previous 2 months. After a loculated pleural effusion was identified on thoracic computed tomography, purulent fluid was drained from the lung and Fusobacterium nucleatum was isolated. The patient was successfully treated for 27 days with amoxicillin-clavulanic acid. This was an atypical presentation of a common micro-organism implicated in lung infections. LEARNING POINTS: Empyema due to Fusobacterium nucleatum can have an atypical presentation, manifesting only with unexplained weight loss and night sweats.F. nucleatum lung infection usually responds well to treatment with common antibiotics.In patients with unexplained weight loss, the differential diagnosis should include cancer, tuberculosis and atypical presentations of other bacterial infections.

Covid 19 and venous thromboembolic disease. Review on a series of patients

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Management of the COPD Patient with Comorbidities: An Experts Recommendation Document.

Background: Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose: To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods: A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results: A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion: This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.

Factores clínicos asociados a enfermedad pulmonar por Aspergillus spp. en pacientes con enfermedad pulmonar obstructiva crónica / Clinical factors associated with pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

OBJETIVO: Conocer las características clínicas y epidemiológicas de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) y aislamiento de especies de Aspergillus en muestra respiratoria e identificar factores que nos ayuden a diferenciar entre colonización e infección. MÉTODOS: Estudio de cohortes retrospectivo en el que se incluyeron todos los pacientes con EPOC y aislamiento de Aspergillus spp. en muestra respiratoria durante un periodo de 12 años. Se asignaron los pacientes a 2 categorías: colonización y aspergilosis pulmonar (AP), que incluye las diferentes formas de presentación clínica. Se aplicó un modelo de regresión logística binaria para identificar los factores predictores de desarrollo de AP. RESULTADOS: Un total de 123 pacientes fueron incluidos en el estudio: 48 (39%) colonizados y 75 (61%) con AP: 68 con AP invasiva probable y 7 con AP crónica. No hubo correlación entre el riesgo de AP y los estadios espirométricos de la clasificación GOLD. Se identificaron como factores predictores independientes de AP en pacientes con EPOC la oxigenoterapia domiciliaria (OR: 4,39; IC 95%: 1,60-12,01; p = 0,004), las bronquiectasias (OR: 3,61; IC 95%: 1,40-9,30; p = 0,008), la hospitalización en los 3 meses previos al ingreso (OR: 3,12; IC 95%: 1,24-7,87; p = 0,016) y la terapia antifúngica frente a Candida spp. en el mes previo (OR: 3,18; IC 95%: 1,16-8,73; p = 0,024). CONCLUSIONES: La oxigenoterapia continua domiciliaria, las bronquiectasias, la hospitalización en los 3 meses previos al ingreso y la utilización de terapia antifúngica frente a Candida spp. en el mes previo se asocian a mayor riesgo de AP en pacientes con EPOC

OBJECTIVE: To explore the clinical and epidemiological characteristics of chronic obstructive pulmonary disease (COPD) patients with Aspergillus spp. isolation from respiratory samples, and to identify which factors may help us to distinguish between colonisation and infection. METHODS: A retrospective cohort study was performed. All patients with COPD and respiratory isolation of Aspergillus spp. over a 12-year period were included. Patients were assigned to 2 categories: colonisation and pulmonary aspergillosis (PA), which includes the different clinical forms of aspergillosis. A binary logistic regression model was performed to identify the predictive factors of PA. RESULTS: A total of 123 patients were included in the study: 48 (39.0%) with colonisation and 75 (61.0%) with PA: 68 with probable invasive pulmonary aspergillosis and 7 with chronic pulmonary aspergillosis. Spirometric stages of the GOLD classification were not correlated with a higher risk of PA. Four independent predictive factors of PA in COPD patients were identified: home oxygen therapy (OR: 4.39; 95% CI: 1.60-12.01; P = .004), bronchiectasis (OR: 3.61; 95% CI: 1.40-9.30; P = .008), hospital admission in the previous three months (OR: 3.12; 95% CI: 1.24-7.87; P = .016) and antifungal therapy against Candida spp. in the previous month (OR: 3.18; 95% CI: 1.16-8.73; P = .024). CONCLUSIONS: Continuous home oxygen therapy, bronchiectasis, hospital admission in the previous three months and administration of antifungal medication against Candida spp. in the previous month were associated with a higher risk of pulmonary aspergillosis in patients with COPD

Clinical factors associated with pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. / Factores clínicos asociados a enfermedad pulmonar por Aspergillus spp. en pacientes con enfermedad pulmonar obstructiva crónica.

OBJECTIVE: To explore the clinical and epidemiological characteristics of chronic obstructive pulmonary disease (COPD) patients with Aspergillus spp. isolation from respiratory samples, and to identify which factors may help us to distinguish between colonisation and infection. METHODS: A retrospective cohort study was performed. All patients with COPD and respiratory isolation of Aspergillus spp. over a 12-year period were included. Patients were assigned to 2 categories: colonisation and pulmonary aspergillosis (PA), which includes the different clinical forms of aspergillosis. A binary logistic regression model was performed to identify the predictive factors of PA. RESULTS: A total of 123 patients were included in the study: 48 (39.0%) with colonisation and 75 (61.0%) with PA: 68 with probable invasive pulmonary aspergillosis and 7 with chronic pulmonary aspergillosis. Spirometric stages of the GOLD classification were not correlated with a higher risk of PA. Four independent predictive factors of PA in COPD patients were identified: home oxygen therapy (OR: 4.39; 95% CI: 1.60-12.01; P=.004), bronchiectasis (OR: 3.61; 95% CI: 1.40-9.30; P=.008), hospital admission in the previous three months (OR: 3.12; 95% CI: 1.24-7.87; P=.016) and antifungal therapy against Candida spp. in the previous month (OR: 3.18; 95% CI: 1.16-8.73; P=.024). CONCLUSIONS: Continuous home oxygen therapy, bronchiectasis, hospital admission in the previous three months and administration of antifungal medication against Candida spp. in the previous month were associated with a higher risk of pulmonary aspergillosis in patients with COPD.

Rationale, design and preliminary results of the GALIPEMIAS study (prevalence and lipid control of familial dyslipidemia in Galicia, northwest Spain).

AIMS: There is little information on the familial nature of dyslipidemias in the Spanish population. This knowledge could have potential diagnostic and treatment implications. The objective of the GALIPEMIAS study was to determine the prevalence of familial dyslipidemia in Galicia, as well as determine the degree of lipid control in the participants. Prevalence of atherosclerotic cardiovascular disease (ASCVD) was also estimated. This paper presents the design, methodology and selected preliminary results. METHODOLOGY: A cross-sectional study was performed in the population aged ≥18 years using cluster sampling and then random sampling. A sample of 1000 subjects was calculated and divided into three sequential phases with a specific methodology for each one. Phase I: selection of subjects from the general population and collection of informed consent documents; Phase II: collection of data from the digital clinical history to select subjects with dyslipidemia according to study criteria; Phase III: personal interview, blood analysis, family tree, and definitive diagnosis of dyslipidemia. Prevalence of different diseases and active medication was analysed. Corrected prevalence (to the reference population) of different risk factors and ASCVD was estimated. RESULTS: Phase I participation was 89.5%. We extracted complete information from 93% of the participants (Phase II). According to the study's own criteria, 56.5% (n = 527) of the participants had some form of dyslipidemia and almost 33.7% of them had familial dyslipidemia with autosomal dominant inherit pattern. The corrected prevalence of ASCVD was 5.1% (95% CI 3.1-7.2). CONCLUSIONS: Dyslipidemia was the most prevalent cardiovascular risk factor in our population with an autosomal dominant inheritance pattern in one out of every three dyslipidemia cases. Approximately, 5.1% of the sample population aged ≥18 has suffered an episode of ACVD.

Real-life treatment of venous thromboembolism with direct oral anticoagulants: The influence of recommended dosing and regimens.

In patients with venous thromboembolism (VTE), the influence on outcome of using direct oral anticoagulants (DOACs) at non-recommended doses or regimens (once vs twice daily) has not been investigated yet. We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to compare the outcomes in patients with VTE receiving DOACs according to the recommendations of the product label versus in those receiving non-recommended doses and/or regimens. The major outcomes were the rate of VTE recurrences, major bleeding and death during the course of therapy. As of March 2016, 1635 VTE patients had received DOACs for initial therapy and 1725 for long-term therapy. For initial therapy, 287 of 1591 patients (18 %) on rivaroxaban and 22 of 44 (50 %) on apixaban did not receive the recommended therapy. For long-term therapy, 217 of 1611 patients (14 %) on rivaroxaban, 29 of 81 (36 %) on apixaban and 15 of 33 (46 %) on dabigatran did not receive the recommended therapy. During the course of therapy with DOACs, eight patients developed VTE recurrences, 14 had major bleeding and 13 died. Patients receiving DOACs at non-recommended doses and/or regimens experienced a higher rate of VTE recurrences (adjusted HR: 10.5; 95 %CI: 1.28-85.9) and a similar rate of major bleeding (adjusted HR: 1.04; 95 %CI: 0.36-3.03) or death (adjusted HR: 1.41; 95 %CI: 0.46-4.29) than those receiving the recommended doses and regimens. In our cohort, a non-negligible proportion of VTE patients received non-recommended doses and/or regimens of DOACs. This use may be associated with worse outcomes.

[Pharmacological treatment of hereditary haemorrhagic telangiectasia]. / Telangiectasia hemorrágica hereditaria: Tratamiento farmacológico.

Hereditary hemorrhagic telangiectasia (HHT) of Rendu-Osler-Weber disease is a multi system vascular dysplasia characterized by the presence of multiple telangiectasias, mainly affecting mucosal tissue and arterial-venous connections. It commonly affects lungs, liver and central nervous system. Bleeding is the most common symptom and its treatment can be surgical or pharmacological. We herein review the systemic therapy that attempts to minimize bleeding as well as blood transfusion therapy. Blood therapy and fibrinolytic treatment especially aminocaproic acid and tranexamic acid are discussed. Danazol, hormone therapy and other less common drugs used in the treatment of HHT are also reviewed.

Telangiectasia hemorrágica hereditaria: tratamiento farmacológico / Pharmacological treatment of hereditary haemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) of Rendu-Osler-Weber disease is a multi system vascular dysplasia characterized by the presence of multiple telangiectasias, mainly affecting mucosal tissue and arterial-venous connections. It commonly affects lungs, liver and central nervous system. Bleeding is the most common symptom and its treatment can be surgical or pharmacological. We herein review the systemic therapy that attempts to minimize bleeding as well as blood transfusion therapy. Blood therapy and fibrinolytic treatment especially aminocaproic acid and tranexamic acid are discussed. Danazol, hormone therapy and other less common drugs used in the treatment of HHT are also reviewed.

[Demand for paediatric emergency care in a community hospital]. / Demanda asistencial de urgencias pediátricas atendidas en un hospital comarcal.

OBJECTIVE: To study the characteristics of paediatric emergency demand and care delivery in the emergency room of a community hospital. DESIGN: Analysis of the care demand and medical attention given to pediatric patients in an emergency room during 2006. Retrospective review of patients' medical reports. SETTING: Emergency room, Hospital da Barbanza, Riveira, A Coruña, Spain. PARTICIPANTS: Random selection of 1330 patients from 3990 cases attended in 2006. MAIN MEASUREMENTS: Age, sex, time of arrival at the emergency room, type of pathology, medical-surgical area, destination on discharge, which medical staff signed the discharge, and length of stay in the emergency room. RESULTS: There were 731 men and 599 women. Demand was greater on the afternoon shift (45%). Discharge destination was mainly to home (94%), with the emergency medical staff signing it in 60.7% of cases and the pediatrician in 34.6%. Children aged 6 or more suffered mainly from trauma; and younger children, from infectious diseases. There were no statistically significant differences between age groups for length of stay in the emergency room, but patients attended by pediatricians stayed longer. CONCLUSIONS: There was a clear majority of little children, especially boys, in our study. Higher afternoon attendance probably occurs because of greater time availability of parents and children. Main causes of emergency pediatric care are infectious diseases and trauma. The child's home is the most frequent destination on discharge. The fact that most discharges are signed by the emergency doctor, together with the increase in emergency paediatric care in recent years, points to the need for constant updating of this medical area by emergency doctors.

Demanda asistencial de urgencias pediátricas atendidas en un hospital comarcal / Demand for paediatric emergency care in a community hospital

Objetivo. Conocer las características de la demanda asistencial, así como de la asistencia que se presta a los pacientes pediátricos en un servicio de urgencias de un hospital comarcal. Diseño. Análisis de la demanda asistencial y de la atención médica prestada a la población pediátrica en el servicio de urgencias durante un año (2006). Revisión retrospectiva de los historiales clínicos de los pacientes incluidos. Emplazamiento. Servicio de Urgencias del Hospital da Barbanza, Riveira (A Coruña). Participantes. Muestreo aleatorio de 1.330 pacientes sobre una población de 3.990 casos atendidos en 2006. Mediciones principales. Edad, sexo, turno de llegada a urgencias, tipo de patología, área médico-quirúrgica, destino en el momento del alta, facultativo encargado del alta y tiempo de estancia. Resultados. Se incluyeron 731 varones y 599 mujeres. La asistencia fue mayor en el turno de tarde (45%). El destino en el momento del alta fue en su mayoría el domicilio (94%), siendo el médico de urgencias el encargado en el 60,7% y el pediatra en el 34,6%. Las consultas de los niños mayores de 6 años fueron básicamente por traumatismos y los menores de esta edad por enfermedades infecciosas. No se encontraron diferencias significativas por grupos de edad con respecto a la estancia en urgencias, pero los pacientes atendidos por pediatras tenían una estancia superior. Conclusiones. Existe un predominio de niños pequeños, especialmente varones, en nuestro estudio. La mayor afluencia en turno de tarde está relacionada con la disponibilidad de tiempo por parte de los padres y de los propios niños. Las principales causas de atención pediátrica urgente son las enfermedades infecciosas y los traumatismos, siendo el domicilio el destino al alta más habitual. El hecho de que una gran mayoría de altas sean gestionadas por el médico de urgencias unido a que la atención urgente pediátrica se está incrementando en los últimos años hace necesaria la constante actualización por parte de los facultativos en este sentido

Objective. To study the characteristics of paediatric emergency demand and care delivery in the emergency room of a community hospital. Design. Analysis of the care demand and medical attention given to pediatric patients in an emergency room during 2006. Retrospective review of patients' medical reports. Setting. Emergency room, Hospital da Barbanza, Riveira, A Coruña, Spain. Participants. Random selection of 1330 patients from 3990 cases attended in 2006. Main Measurements. Age, sex, time of arrival at the emergency room, type of pathology, medical-surgical area, destination on discharge, which medical staff signed the discharge, and length of stay in the emergency room. Results. There were 731 men and 599 women. Demand was greater on the afternoon shift (45%). Discharge destination was mainly to home (94%), with the emergency medical staff signing it in 60.7% of cases and the pediatrician in 34.6%. Children aged 6 or more suffered mainly from trauma; and younger children, from infectious diseases. There were no statistically significant differences between age groups for length of stay in the emergency room, but patients attended by pediatricians stayed longer. Conclusions. There was a clear majority of little children, especially boys, in our study. Higher afternoon attendance probably occurs because of greater time availability of parents and children. Main causes of emergency pediatric care are infectious diseases and trauma. The child's home is the most frequent destination on discharge. The fact that most discharges are signed by the emergency doctor, together with the increase in emergency paediatric care in recent years, points to the need for constant updating of this medical area by emergency doctors